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Emergency department mortality rates plummet over 15 years

Emergency departments across the country saw a nearly 50% drop in adult deaths over a 15-year period, according to a new study published in Health Affairs.

Although the study couldn't pinpoint an exact cause for the changes in ED mortality rates from 1997 to 2011, the authors noted that changes in pre-hospital, emergency and palliative care could all be factors.

“There have been a lot of changes with healthcare in the past couple decades,” said Dr. Hemal Kanzaria, an assistant professor in the University of California at San Francisco's department of emergency medicine and co-author of the study. “There's been an increased focus on end-of-life care and understanding and engaging patients in their care.”

Kanzaria and his two co-authors looked at data from the National Hospital Ambulatory Medical Care Survey from 1997 to 2011, sifting through records that represented 1.3 billion emergency department visits during that time. They found that ED mortality rates dropped from 1.48 per thousand in 1997 to 0.77 per thousand in 2011, a 48% reduction.

According to the study, those who died in the emergency department were more likely to be white males with severe triage acuity scores or patients visiting an emergency department in a rural area or the South.

But the study's authors and other physicians warned that better mortality rates shouldn't be considered a quality metric for emergency physicians. Nearly two-thirds of emergency department deaths stemmed from patients who were in cardiopulmonary arrest, unconscious or dead on arrival, according to the study.

Deaths in the emergency department are quite rare, according to Dr. Robert Femia, chair of NYU Langone Medical Center's department of emergency medicine. Femia said he has seen those rates drop even more thanks to innovative and evolving emergency department protocols.

“As new evidence comes out, emergency departments are constantly retweaking their protocol,” Femia said.

At NYU Langone, the emergency room has found ways to shave minutes or even hours off of standard procedures to treat patients more efficiently, whether it's providing stroke patients with clot-busting drugs while still in a CAT scan machine or meeting heart attack patients at the ambulance door with a team that can take them straight to the cardiac lab.

The hospital has also created integrated, multidisciplinary teams to treat strokes, infections and sepsis, and all these innovations have helped prevent deaths in the emergency department.

“We're constantly implementing new ways to get to diagnoses a little quicker, a little more accurately,” Femia said.

But the innovations causing the downturn in mortality rates go beyond the bounds of the emergency room, according to the study. Although more than half of older Americans go to an emergency department during their last month of life, there has been a 20% decrease in hospital deaths and a 50% increase in home deaths from 1989 to 2007 as patients increasingly choose to die at home or in hospice facilities rather than hospitals.

“I think (Kanzaria and I) both feel as clinicians that the emergency department is not the optimal place for patients to ultimately die,” said Marc Probst, an assistant professor of emergency medicine at the Icahn School of Medicine at Mount Sinai and co-author of the study. “There are better places. I think it's something as a healthcare system that we're working on in making the final experience as painless as possible not just for the patient but for the family.”


Erica Teichert assigns, edits and directs news coverage for Modern Healthcare’s website and magazine. She previously served as the publication’s New York bureau chief and legal reporter. Before joining Modern Healthcare in 2016, she worked at Law360 as legal newswire’s first D.C. bureau chief after three years as a court reporter covering the U.S. Supreme Court, D.C. Circuit and other federal courts and agencies. Prior to that, she worked as an associate editor for FierceMarkets. She has a bachelor's degree in communications with a print journalism emphasis from Brigham Young University.

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